BackgroundThe pharmacokinetic basis of magnesium sulphate (MgSO 4) dosing regimens for eclampsia prophylaxis and treatment is not clearly established.ObjectivesTo review available data on clinical pharmacokinetic properties of MgSO 4 when used for women with pre‐eclampsia and/or eclampsia.Search strategy MEDLINE, EMBASE, CINAHL, POPLINE, Global Health Library and reference lists of eligible studies.Selection criteriaAll study types investigating pharmacokinetic properties of MgSO 4 in women with pre‐eclampsia and/or eclampsia.Data collection and analysisTwo authors extracted data on basic pharmacokinetic parameters reflecting the different aspects of absorption, bioavailability, distribution and excretion of MgSO 4 according to identified dosing regimens.Main resultsTwenty‐eight studies investigating pharmacokinetic properties of 17 MgSO 4 regimens met our inclusion criteria. Most women (91.5%) in the studies had pre‐eclampsia. Baseline serum magnesium concentrations were consistently <1 mmol/l across studies. Intravenous loading dose between 4 and 6 g was associated with a doubling of this baseline concentration half an hour after injection. Maintenance infusion of 1 g/hour consistently produced concentrations well below 2 mmol/l, whereas maintenance infusion at 2 g/hour and the Pritchard intramuscular regimen had higher but inconsistent probability of producing concentrations between 2 and 3 mmol/l. Volume of distribution of magnesium varied (13.65–49.00 l) but the plasma clearance was fairly similar (4.28–5.00 l/hour) across populations.ConclusionThe profiles of Zuspan and Pritchard regimens indicate that the minimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted level. Exposure–response studies to identify effective alternative dosing regimens should target concentrations achievable by these standard regimens.Tweetable abstractMinimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted therapeutic level.

Objective To investigate life-threatening maternal complications related to hypertensive disorders of pregnancy (HDP) in Nigerian public tertiary hospitals.Design Secondary analysis of a nationwide cross-sectional study.Setting Forty-two tertiary hospitals.Population Women admitted for pregnancy, childbirth or puerperal complications. Method All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to HDP were prospectively identified using the WHO criteria over a 1-year period.Main outcome measures Incidence of SMO, health service events, case fatality rate, and mortality index (% of maternal death/ SMO).Results Out of 100 107 admissions for maternal complications, 6753 (6.8%) women had HDP. Pre-eclampsia (PE) (54.5%) and eclampsia (E) (30.4%) were the most common HDP recorded. SMO occurred in 587 women with HDP: 298 maternal nearmisses and 289 maternal deaths. The majority (93%) of the women with SMO due to HDP were admitted in a critical condition. The median diagnosis-definitive intervention interval was over 4 hours in a quarter of women who died from HDP. For PE and E, case fatality rates were 1.9 and 10.4%, respectively, although both conditions had a similar mortality index of 49.3%. Lack of antenatal care and place of residence further than 5 km from the hospital were associated with maternal death.Conclusions Severe maternal outcomes from HDP were due to late presentations and health system challenges. To reduce maternal deaths from HDP, health system strengthening that would engender early hospital presentation and prompt treatment is recommended.Tweetable abstract Eclampsia is the leading cause of maternal death in Nigerian hospitals.Please cite this paper as: Adamu AN, Okusanya BO, Tukur J, Ashimi AO, Oguntayo OA, Tunau KA, Ekele BA, Oladapo OT. Maternal near-miss and death among women with hypertensive disorders in pregnancy: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 (S3): 12-18.

Despite the 3.9 % prevalence, routine screening for hepatitis C virus infection in pregnancy is unjustified. Risk-based screening using locally prevailing risk factors with antenatal monitoring and postpartum treatment of women with hepatitis C antibodies is recommended.

There is elevated serum lipid in pregnancy irrespective of preeclampsia developing. The positive correlation of maternal serum lipids to preeclampsia suggests a casual relationship.

No abstract